Usability in Healthcare Software: From Myth to Fact

Although they are self-explanatory, some of these myths are so ingrained that they need to be examined.

Myth #3 – The more functionality, the better

This myth is tempting, especially in systems such as Electronic Health Records that feature considerable functional loads that can lead directly to usability failures. Software functionality design should be based on prior user research, in their real use environment, where this type of software should be able to help them perform their tasks more effectively and in less time.

Creating functionalities focusing on the market and not on the use is an error. It would be more suitable to think that “more is less”, in this case.

Myth #6 Usability is subjective

This is a myth that cannot be further from reality. Usability issues, in addition to causing frustration, lead to a loss of efficiency and effectiveness during the care process, and predisposes to error. Usability can be measured through different techniques, such as usability tests that measure the execution of workflows at a certain time and detect failures and errors, and are complemented by other methodologies, such as the SUS Scale (System Usability Scale), PSSUQ, among others.

Myth #7 Usability is the same thing as coloring screens, applying styles, and pretty designs

Perhaps this myth is one of the most sadly extended ones and minimizes the importance and the commitment of technology providers to offering the user the best software-use experience.

To design the user interaction with a system or application, we need to know and optimize the task flow that each profile performs, meet their expectations and needs and above all, provide an environment that is as natural and simple as possible to execute these tasks quickly, easily and securely. This includes the visual design of the interface, obviously, but that is only part of the experience.

The scope of usability in health information technology

The ISO defines usability as the extent to which a product can be used by specified users to achieve specified goals with effectiveness, efficiency, and satisfaction in a specified context of use ⁶.

In the case of technologies developed for the healthcare industry, usability takes on a special dimension.
Studies show that patients treated with the help of a well-designed and usable Electronic Health Record, have between 17% and 30% less chance of experiencing an adverse event, which suggests that hospitals that possess this technology are capable of providing more coordinated patient care from admission to discharge, and increase patient safety.

The problems stemming from a lack of usability have a negative impact on the quality of patient care and the doctor – patient interaction, frustrating health professionals. Poor usability also increases the time spent documenting the care process, and interferes with patient care.

On the other hand, poor understanding of the context of the use of information during software development can lead to an overload of information that hinders decision making ^9,10,11,12.

Such is the magnitude of this problem, that the ECRI (Emergency Care Research Institute), ranked this in sixth place in “the 10 risks of the use of Electronic Health Record”, specifically the risk stemming from the poor design and poor execution of the work flows in the Health Record; “alarm fatigue” due to misconfiguration, and concerns about the integrity of the data ¹³.

Usability in a critical sector for security

The healthcare industry is highly sensitive to security. Countries such as the United States are studying ways to implement best usability practices in the Electronic Health Record systems, as well as security policies based on the experiences in other complex industries such as nuclear, aeronautics, energy extraction, military and finance ^14 15.

There is no doubt that technology must be designed, developed and implemented focusing on its usability and safe use, based on design processes that focus on the user and their experience (UCD), a commitment that suppliers must subscribe to, with their users.

Another example of the importance of this topic for the industry is a new research project by the Agency for Healthcare Research and Quality in the United States (AHRQ), funded with a budget of $1,225,562 USD, which aims to develop new guidelines for the implementation and design of software that is user-focused and evidence-based, with the aim of helping health technology providers to continue improving the usability of information technologies ¹⁶.

Health information technologies will increasingly focus on people

In the digital economy, the patient’s experience is at the core of the transformation process, and in that sense we are called to maximize their experience, designing interactions that are increasingly based on human behavior ¹⁷.

The future has already arrived and reveals a scenario where technology adapts more and more to the user and learns from their behavior. For this reason, many experts are already talking about how the new user interface (UI) will be converted into AI (Artificial Intelligence)  ¹⁸.

The present-day experience of the user looking up information in a previously organized structure, interacting through keyboards or buttons with a device, will become a more natural, human and personalized experience, where the user interacts with more conversational interfaces.

We are convinced that contextual intelligence and continuous learning algorithms will soon guide the interaction process of patient and health professional with technology, providing a better experience and maximizing the benefit and value that they already contribute.

This article is part of the Whitepaper: “Improving usability and optimizing the experience of health professionals and patients through the use of health information technologies”, awaiting formal publication.

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References

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^{2 A. Kushniruk, J. Kaipio, M. Nieminen, H. Hyppönen, T. Lääveri, C. Nohr, A. M. Kanstrup, M. Berg Christiansen, M.-H. Kuo, and E. Borycki1. Human Factors in the Large Experiences from Denmark, Finland and Canada in Moving Towards Regional and National Evaluations of Health Information System Usability. Yearb Med Inform. 2014; 9(1): 67–81. Contribution of the IMIA Human Factors Working Group [on-line]}

^{3Jennifer Zelmer, Elettra Ronchi,Hannele Hypponen,Francisco Lupiañez Villanueva, et all. Benchmarking Pilot Group. International health IT benchmarking learning from cross country comparisons. Journal of the American Medical Informatics Association , 24(2), 2017, 371–379 [on line]}

^{4 Raj Ratwani, Ph.D. Director científico del Centro Nacional de Factores Humanos en Salud MedStar. Washington DC.}

^{5 Healthcare Usability. (2013). Top 10 healthcare Usability Myths Debunked. [on line]}

^{6 ISO 9241-11:1998 “Guidance on usability” https://www.iso.org/standard/16883.html.}

^{7 Jennifer Bresnick. Can Full EHR Adoption Decrease Adverse Patient Safety Events? Adverse patient safety events are significantly less common in hospitals using a fully electronic EHR system, new AHRQ research suggests. [on line]}

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^{16 Developing Evidence-Based, User-Centered Design and Implementation Guidelines to Improve Health Information Technology Usability (Maryland) MedStar Research Institute. R01 HS023701. 30/09/2015 al 31/7/2020. [on line]}

^{17 [Whitepaper] Mario Chao. Los retos de la transformación digital para las organizaciones de salud. ¿Cómo Innovar y permanecer competitivos en tiempos de cambios acelerados? [on line]}

^{18 Accenture. Design for humans. Inspire new behavior.[on line]}